1. Field
This invention relates to surgical procedures and apparatus. More particularly, this invention discloses apparatus and procedures for performing therapeutic arthroscopic surgical procedures.
2. State of the Art
Arthroscopic diagnosis using an arthroscope and its associated equipment is well known. M. Watanabe, Takeda and H. Ikeuchi, Atlas of Arthroscopy (Igaku Shoin Ltd., Tokyo, Second Ed. 1969). Use of the arthroscope permits a treating physician to actually view the interior of an articulate joint (e.g., knee) for the purpose of diagnosing conditions. Although the arthroscope has facilitated diagnosis, no significant improvement in surgical procedures associated with articulate joint maladies has ensued.
Arthroscopic diagnosis is generally effected through one or two short stab wounds. The stab wounds have been found to heal rather quickly and to cause reduced discomfort and disability for the patient. However, treatment of diagnosed conditions may require surgery. Surgical treatment of an articulate joint is typically effected through long surgical incisions which serverely disables a patient for weeks, even months, as the wound heals.
For example, meniscectomy (cartilage removal) of the knee is a standard, common, well accepted surgical procedure. The conventional technique requires an arthrotomy incision of two to three inches in length through the skin and subcutaneous tissue of the patient proximate his knee. Thereafter the damaged or defected cartilage is removed and the incision closed. Postoperative hemorrhage, inflammation and pain inhibit the quadricep muscle mechanism and prolong disability because of the extended incision. After conventional meniscectomy at least three to four days of hospitalization are required. After hospitalization, at least two weeks of crutch walking and often four or more weeks of lost time from work or other physical activity is experienced by the patient. Rehabilitation during this time is typically supervised by a physical therapist with concomitant cost to the patient.
Partial meniscectomy is now being accomplished by a very small number of Arthroscopists through small stab wound incisions. Partial meniscectomy consists of removing only a small torn part of the meniscus sparing the major attached outer rim. A partial meniscectomy results in less hemorrhage, inflammation and noticeably short disability when performed through stab wounds. A parial meniscectomy is effected using long metal barrels which are 4 to 7.5 millimeters in diameter and very thin straight long handled instruments. The barrels are totally unyielding and severely restrict the use of instruments and in turn the acceptability of the procedure. Indeed, the apparatus and procedures which are known have not been sufficient to permit any significant effect of surgical knee procedures except through extended incisions (e.g., large open wounds).
Other deficiencies or maladies associated with articulate joints are similarly painful and expensive in treatment. Extensive surgical procedures after diagnosis (for example, by arthroscope) consume a significant amount of time for attending surgeons, hospital personnel, and the patient. The associated cost of the procedure is in turn quite significant.
Known instrumentation is not suitable or adapted for use in the vicinity of an articulate joint or to facilitate operative surgical procedures in an articulate joint area. For example, bacterial seals such as that disclosed in U.S. Pat. No. 3,815,577, have been used to create a permanent communication between the interior of the body and the anterior of the body. U.S. Pat. No. 3,663,965 (Lee Jr. et al.) similarly attempts to provide a bacterial resistant device which nonetheless permits communication between the interior and anterior portions of the body. Such devices are made only of solid material and restrict instrument passage and manipulation.
U.S. Pat. No. 3,253,594 (Mathews et al.) discloses a peritoneal cannula. This device is designed to be left in the abdomen or within the peritoneum over a long period of time. Its purpose is to pass fluids in and out of the abdomen for procedures including, for example, peritoneal lavage. The device is designed to prevent infection and to seal and self-retain safely and effectively. It is a rigid metal device with no provision for passing instruments of any kind whatsoever into or out of the peritoneal cavity.
U.S. Pat. No. 3,960,143 (Terada) discloses an Endoscope which is used primarily in the abdomen and the peritoneal cavity and secondarily in the chest area. The device provides for means to conduct biopsies within the respective cavities by use of improvements which limit the amount of discomfort or pain experienced by the patient during the course of the biopsy procedure and subsequent thereto. No provision is made to allow for other surgical instruments to pass therethrough.
Other references which may be of interest include U.S. Pat. No. 3,608,544 (Schnepper); U.S. Pat. No. 3,964,468 (Schulz); U.S. Pat. No. 3,989,033 (Halpern et al.); U.S. Pat. No. 3,173,414 (Guillant). The above-mentioned patents appear to describe apparatus for performing biopsies and related surgical procedures involving the removal of a small sample of tissue for diagnostic purposes.